Bridging The Gap

The issue of substance abuse and Heroin particularly, has been all over social media and the news lately. There are some Cities and Towns doing great things, implementing new programs. One of the things I heard from Gov. Charlie Baker during his campaign was that drug abuse was going to be a focus. A lot needs to be done, because this is getting worse and worse, daily.

Gloucester recently released a story stating how it is going to provide services to any addict that comes to the police station for help. The Police Chief has created a program that allows an addict to surrender drugs to the police department and they will help with detox and recovery without fear of arrest. It also allows for addicts apprehended with drugs to make a choice to enter the legal system or complete an inpatient program; along with using some seized money from criminal activity to fund this and other programs. I see this as a great program, but it has me wondering about the loop holes. The first thing I thought of was how do they monitor whether an addict who is arrested completes the inpatient program? And who pays for that? One of the biggest issues I had with JoDee is that I am gainfully employed. And so is her dad. This worked against her because she didn’t qualify for Medicaid because she had fully covered insurance and we didn’t meet the financial standard. Private insurance is ridiculous when it comes to addiction. Some are better than others.

When JoDee went to detox the very first time, she was covered through Harvard Pilgrim under ex-husband numero dos insurance. HP doesn’t restrict where she can go. As long as they take HP she could go there so her first detox was at McLean’s in Belmont. And she relapsed shortly thereafter and she went back to the hospital and then to another detox and ran from there and then to another hospital and so and so on. My problem with HP was that the last time we went to the hospital they would not place her in another facility. Not that I can really blame them. She was basically making the rounds for three full weeks. So they capped her. They offered her methadone/suboxone or an IOP. JoDee was way too deep into addiction to just go to an IOP. I detoxed her at home for the first time, which was horrendous, especially because I had nothing to detox her with other than trazadone for sleep. Eventually she went to rehab in Arizona and we all know how that turned out.

Meanwhile, back on the Brayden Ranch, divorce from Ex-Numero II finally commenced and JoDee was covered under her father’s insurance which was Tufts. Tufts coverage regarding substance abuse is deplorable. She is capitated to go to detox or any program through the hospital organization that her primary care is associated, and that’s it. There are only two places that are available to her based on this criteria and one of them, her drug supplier walked onto (even though it was a locked unit) with a syringe full of heroin which she shot up in the bathroom. By the time I got to the facility to see her she was sitting in a chair drooling on herself, with an empty cup upside down in her lap because she spilled it all over herself. I can’t imagine her going back there. The other option is a psych ward. They take general psych, geri-psych, drug abuse, you name it. Neither are great options however, the psych ward actually took really good care of her the few times she has been there. It isn’t my favorite place for her too go, but I can’t really complain. It served its purpose. However, under Tufts she is only allowed further treatment program, inpatient, one time. A life time maximum. So the first time she relapsed under Tufts, the case-worker suggested she try an outpatient program again. The second time she relapsed she got 10 days at a step-down unit. Now she is tapped out. She can get detox and that’s it. No inpatient rehab, not even 30 days of rehab. To me, this is where we need to concentrate on healthcare reform. Since we have done away with most state hospitals, and the ones we still have are trying to cater to the larger mental health population with little to no help and nowhere to go, there are fewer places for addicts to get help. I can’t help but wonder if the relapse rate would reduce if there was quality healthcare to begin with. Tufts allow us to go to Children’s Hospital for Jay J’s heart condition. I can be seen at St. Elizabeth’s for my neurological needs, but it hen picks which detox or after-care a person can get? That seems criminal to me. They are targeting the weakest of the population that don’t have the wits about them to defend themselves. Suckers are in bed with the mob if you ask me.

Even when she was sectioned to WATC I received a lovely letter, eloquently written, from Tufts stating that they understand that JoDee has an addiction, and that she was court remanded to the facility but they ain’t gonna pay, no way, no how. Which is why JoDee couldn’t stay after 20 days. That is all the court remanded her for. If she got Tufts to pay for an additional week or two more, she would have eeked out a 30 day stay somewhere. But that is a pipe-dream… pun intended. Had a program like Gloucester been around then, I would have walked JoDee into that police station to get whatever help they could give me. And therein lies the problem- JoDee may very well have entered into some program (do you have to be a Gloucester resident to get help through this program?) but she would have wasted their time and resources because she wasn’t ready. Something it took me a long time to figure out. I can’t be more ready than she is. Even if I am at the end of my rope, even if I can’t take one more relapse, she may have it in her and until she is ready to surrender, I can’t surrender for her. So I wonder, how much of this program will be abused by addicts trying to stay out of jail? How many will have parents, like me, dragging their kid down to sign them up for whatever they can get? Don’t get me wrong, it’s a giant, wonderful, monumental start and I applaud Gloucester for this. I think they will have to work out the logistics as they move through the process.

I would love to see more Towns and Cities adopting such programs, but I would also like to see the state take the lead. When is Massachusetts going to regulate the health insurance in terms of mental health as they do for senior care, maternity care, pediatric care, cancer care. All of those things are so important and I am so glad that there is no more pre-existing condition, or control over which OB a woman uses. But those same standards should apply to our addicts. When JoDee was in need I was aggressive, nasty, and relentless. And that was on a good day. I know that by continuing to ask, beg, plead, make phone calls, and having worked in healthcare most of my adult life, know the lingo, it helped JoDee get to and in places that maybe would not have been realized. Not everyone has that. It should be necessary to do that. Not to mention the number of health officials that suggested I find a way to get her on Medicaid. That was another thing that annoyed me. Why does she have to get on state health insurance to qualify for better care? Isn’t that sort of defeating the purpose? The same care received under a state plan should be the same care received under a private plan. Where is the incentive to be a working member of society if any single person can be better covered on a state dime? When we are living in a time that budget cuts for education/health services/elder programs are happening, it would make sense that private health insurance be held to the same standard as state insurance so to encourage others to use insurance through their job, thus lowering the amount of money spent in Medicaid each year. But what do I know… I’m just the mother of an addict.

The biggest obstacle to getting an addict help, often, is the addict. There are programs, and to quote JoDee’s N/A basic text, it works if you work it. That really is true. The addict has to be ready and willing. My concern is twofold: 1. Can we do a better job of identifying those at risk of being addicts so to prevent it before it starts. 2. Can we do a better job keeping them alive until they are ready to surrender? I don’t know the answers to these questions. I don’t even know where to begin but I know that they are important in the battle against substance abuse. The statistics that come out every month about the amount of heroin going around, the number of overdoses both nearly fatal and fatal and the number of available beds to treat these addicts is frightening. What I also find frightening is that these numbers are probably under-reported. How many times was someone treated with Narcan but never went to the hospital? How many cases of suicide were heroin related? It is hard to quantify substance abuse in reports because you’re talking about a group of individuals whose daily purpose is to stay under the radar to continue using.

In summary, I think more places should follow in the steps of Gloucester and develop some beginning plan, even if it needs to evolve as time goes on, to combat the problem with substances. I think that our state should be countering that with better legislature that does not allow health insurance companies to pigeon hole the treatment our addicts need desperately. I believe that drug replacement therapy has a purpose and a place but shouldn’t be used instead of inpatient treatment. I hope that our schools can derive a plan that highlights students and families at risk for substance abuse and is able to introduce programs and guidance to reduce the number of students graduating high school, already addicted to something. And I hope that it happens sooner than later…. Every day 100 American’s die from drug overdose. 100 people. That is an average of 36,500 people a year. To give you an idea of how many people that is, Fenway Park holds roughly 37000, and TD Garden 17,0000, and Gillette Stadium 68,000. The number of people who died would fill TD Garden twice, or half of Gillette. That is a lot of broken hearts, ruined families, parentless children, childrenless parents, and an ocean of tears. That is 36,500 to many. And I can only imagine that number will continue to grow without everyone doing their part to end the madness.



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